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Case-control study of neurodevelopment in deformational plagiocephaly
Matthew L Speltz1, Brent R Collett, Marni Stott-Miller
1Seattle Children's Hospital, 4800 Sand Point Way, N.E., Mailstop W-3636, Seattle, WA 98105, USA. mspeltz@u.washington.edu
Insights
Infants with deformational plagiocephaly (DP) show early neurodevelopmental disadvantages, particularly in motor skills. This suggests DP is a risk marker, warranting close developmental monitoring by pediatricians.
Area of Science:
- Pediatric Neurodevelopment
- Craniofacial Abnormalities
Background:
- Deformational plagiocephaly (DP) is a common condition in infants.
- The neurodevelopmental implications of DP require further investigation.
Purpose of the Study:
- To assess and compare the neurodevelopment of infants with and without DP at 6 months of age.
- To identify potential associations between DP severity and neurodevelopmental outcomes.
Main Methods:
- Utilized the Bayley Scales of Infant Development III (BSID-III) for neurodevelopmental assessment.
- Administered assessments to 235 infants with DP and 237 controls.
- Quantified DP severity using 3D head photography analyzed by blinded craniofacial experts.
Main Results:
- Infants with DP performed significantly worse across all BSID-III scales (cognitive, language, motor) compared to controls.
- Motor composite scores were approximately 10 points lower in the DP group (P < .001).
- Cognitive and language composite scores were approximately 5 points lower in the DP group (P < .001).
Conclusions:
- Deformational plagiocephaly is associated with early neurodevelopmental disadvantage, most pronounced in motor functions.
- DP serves as a marker for increased risk of developmental delays, not necessarily a direct cause.
- Pediatricians should closely monitor the development of infants diagnosed with DP.
Objective:
We assessed the neurodevelopment of infants with and without deformational plagiocephaly (DP), at an average age of 6 months.
Methods:
The Bayley Scales of Infant Development III (BSID-III) were administered to 235 case subjects and 237 demographically similar, control participants. Three-dimensional head photographs were randomized and rated for severity of deformation by 2 craniofacial dysmorphologists who were blinded to case status.
Results:
We excluded 2 case subjects with no photographic evidence of DP and 70 control subjects who were judged to have some degree of DP. With control for age, gender, and socioeconomic status, case subjects performed worse than control subjects on all BSID-III scales and subscales. Case subjects' average scores on the motor composite scale were approximately 10 points lower than control subjects' average scores (P < .001). Differences for the cognitive and language composite scales were approximately 5 points, on average (P < .001 for both scales). In subscale analyses, case subjects' gross-motor deficits were greater than their fine-motor deficits. Among case subjects, there was no association between BSID-III performance and the presence of torticollis or infant age at diagnosis.
Conclusions:
DP seems to be associated with early neurodevelopmental disadvantage, which is most evident in motor functions. After follow-up evaluations of this cohort at 18 and 36 months, we will assess the stability of this finding. These data do not necessarily imply that DP causes neurodevelopmental delay; they indicate only that DP is a marker of elevated risk for delays. Pediatricians should monitor closely the development of infants with this condition.
